Healthy and satisfied

Enquesta de salut de Catalunya

Latest data from the 2013 Health Survey shows that 81,1% of the population consider themselves as healthy, slightly better that in 2010 that was 79,3%. Regarding satisfaction, 86,9% of population is satisfied with public health services, again better than 2010 that was 84,7%. Though in 2012 results were a little bit better.
In the details of the results you'll find that obesity and overweight is the biggest issue to address in my opinion. There is still a lot to do on tobacco and alcohol, but data shows some improvement.
This health survey should be broadcast in the media and efforts to promote healthy behaviours should raise. Unfortunately nowadays media is focused on negative messages and this issue lies far from journalists' interests.

Desxifrant el rellotge vital que portem dins

 Are your organs ageing well? The blood holds clues

Organ aging signatures in the plasma proteome track health and disease

L'envelliment deixa senyals a les cèl·lules i aquests canvis bioquímics provoquen danys a òrgans i poden causar finalment la mort. Saber perquè i com envellim  ha esdevingut un repte per a molts investigadors, és com treballar sobre la causa de les causes de la salut. Es tracta de conèixer els canvis moleculars en els òrgans humans quan anem envellint. L'article de Lopez-Otin, Blasco i Serrano a Cell aquest gener passat mostrava una revisió àmplia de l'estat de la qüestió. Article per llegir i guardar.

Ara a Stanford han trobat la manera d'identificar proteïnes a la sang que assenyalen l'envelliment de determinats òrgans del cos. No tots els òrgans evolucionen per igual i quan un s'espatlla pot afectar un altre. Hi havia aportacions anteriors molt importants des de l'epigenoma que ja ho apuntaven. Ara bé, el que apareix ara és molt més holístic i pràctic, i l'aprenentage automàtic ha ajudat a assolir el resultat. A l'editorial de Nature diuen:

To explore how organs age, Oh and his colleagues first analysed nearly 5,000 proteins in blood samples from 1,398 healthy adults. They identified about 850 proteins that originated mainly from a single organ and trained a machine-learning algorithm to predict a person’s age on the basis of the levels of these proteins. They validated their model using blood samples from more than 4,000 other people.

The results showed that an organ’s biological age is linked to disease risk. For example, roughly 2% of participants had accelerated heart ageing — that is, their levels of blood proteins relating to heart ageing differed substantially from those of other people of the same age. Having a prematurely old heart was linked to a 250% increased risk of heart failure, the authors found.

Atès que el rellotge vital de cadascú ens diu l'edat dels òrgans, estem a punt de poder identificar amb precisió quin és el risc personal d'emmalaltir. Aquest és un salt rellevant en el coneixement, han trobat els biomarcadors dels biomarcadors. 

La qüestió immediata que apareix és què cal fer amb aquesta nova informació del risc? Cal saber-la tota? Hi ha riscos mitigables? evitables?. L'entorn i els comportaments, com ajudaran a millorar i no espatllar els riscos ja existents?

PS. Grifols segueix la pista d'això, hi és al darrera. Mireu el darrer signant de l'article Wyss Coray, i la seva empresa Alkahest.

PS. Si us llegiu l'article sencer de Nature, hi trobareu detalls de molt interès, com aquest:

The kidney ageotype was the most significantly associated with metabolic diseases (diabetes, obesity, hypercholesterolaemia and hypertension), the heart ageotype was the most significantly associated with heart diseases (atrial fibrillation and heart attack), the muscle ageotype was the most significantly associated with gait impairment, the brain ageotype was the most significantly associated with cerebrovascular disease and the organismal ageotype was the most significantly associated with Alzheimer, AD. 

 At the population level, the two most significant associations between disease and age gap were between the kidney age gap and metabolic disease traits.

Si les proteïnes del plasma prediuen envelliment de l'òrgan i aquest prediu el risc de malaltia...aleshores ens cal conèixer com tenim les proteïnes del plasma. Ara bé, no m'interessa conèixer el risc de malalties no "accionables", no ho vull saber. Per altra banda, si que vull saber aquells riscos d'emmalaltir sobre els que puc contribuir a reduir-los o evitar-los, o aquells que l'entorn i el sistema de salut hi pot contribuir. 

Robert Mapplethorpe a la Galeria Senda

Fighting obesity and sedentarism

 Healthy Eating and Active Lifestyles

La petjada de la COVID

 Determinants of the onset and prognosis of the post-COVID-19 condition: a 2-year prospective observational cohort study

Trobo que no s'en parla prou de la petjada que la COVID ha deixat a alguns dels nostres cossos. L'Eric Topol se n'ha preocupat força i n'ha fet aquest resum:

I on diu Spain podeu considerar que diu Catalunya, perquè es refereix a aquest article. I la troballa després de 2 anys d'estudiar la població amb Post-Covid condition PCC, és aquesta:

The study included 548 individuals, 341 with PCC, followed for a median of 23 months (IQR 16.5–23.5), and 207 subjects fully recovered. In the model with the best fit, subjects who were male and had tertiary studies were less likely to develop PCC, whereas a history of headache, or presence of tachycardia, fatigue, neurocognitive and neurosensitive complaints and dyspnea at COVID-19 diagnosis predicted the development of PCC. The cluster analysis revealed the presence of three symptom clusters with an additive number of symptoms. Only 26 subjects (7.6%) recovered from PCC during follow-up; almost all of them (n = 24) belonged to the less symptomatic cluster A, dominated mainly by fatigue. Recovery from PCC was more likely in subjects who were male, required ICU admission, or had cardiovascular comorbidities, hyporexia and/or smell/taste alterations during acute COVID-19. Subjects presenting with muscle pain, impaired attention, dyspnea, or tachycardia, conversely, were less likely to recover from PCC.

Table 4Characteristics of the post-COVID-19 condition clusters.

	Cluster A	Cluster B	Cluster C
N (%)	139 (40.8)	152 (44.6)	50 (14.2)
Age, years, median (IQR)	50 (42–57)	47 (38–56)	45 (39–51)
Sex, female, N (%)	73 (52.5)	120 (78.9)	45 (90)
Hospitalization, N (%)	65 (46.8)	52 (34.2)	13 (26)
Intensive care, N (%)	10 (7.2)	5 (3.3)	1 (2)
Comorbidities, N (%)
Allergy	31 (22.3)	56 (36.8)	20 (40)
Obesity	32 (23.0)	39 (25.7)	13 (26.0)
Dyslipidemia	30 (21.6)	43 (28.3)	9 (18.0)
Hypertension	34 (24.5)	25 (16.4)	8 (16.0)
Lung disease	21 (15.1)	31 (20.4)	6 (12.0)
Persistent symptoms, N (%)
Fatigue	100 (71.9)	139 (91.4)	48 (96.0)
Neurocognitive complaints	62 (44.6)	128 (84.2)	46 (92.0)
Dyspnea	45 (32.4)	131 (86.2)	44 (88.0)
Headache	41 (29.5)	103 (67.8)	44 (88)
Myalgia	31 (22.3)	98 (64.5)	33 (66)
Arthralgia	39 (28.1)	92 (60.5)	47 (94)
Chest pain	31 (22.3)	76 (50.0)	45 (90)
Tachycardia	19 (13.7)	83 (54.6)	39 (78.0)
Cough	18 (12.9)	64 (42.1)	19 (38.0)
Neurosensitive symptoms	31 (22.3)	66 (43.4)	40 (80.0)
Diarrhea	14 (10.1)	59 (38.8)	26 (52.0)
Low grade fever	13 (9.35)	36 (23.7)	21 (42.0)
Smell alterations	34 (24.5)	38 (25)	30 (60)
Dermatological alterations	24 (17.3)	36 (23.7)	43 (86)
Dysphagia	9 (6.47)	18 (11.8)	27 (54)
Dysphonia	10 (7.19)	29 (19.1)	19 (38)
Recovery from PCC, N (%)	24 (17.3)	1 (0.7)	1 (2.0)

I la petjada després de dos anys persisteix encara en bona part de la població amb PCC. I moltes coses que encara no sabem... 

L'economia del comportament i l'obesitat

Eating Behavior and Obesity Behavioral Economics Strategies for Health Professionals

Sabem que majoritàriament els indicadors de salut dels catalans que empitjoren, tenen relació amb els comportament, amb els hàbits saludables. I que l'obesitat es troba al capdavant.
Entendre què cal fer és crucial. Però malauradament tenim visions i estratègies de curta volada. Ara acaba d'aparèixer un llibre que ofereix noves perspectives tot introduint l'economia del comportament davant el problema de l'obesitat. Diu:

There are two ways of thinking about influencing behavior. The first is based on the standard rational model. That is, infl uencing what people consciously think about by increasing knowledge and awareness (known as the refl ective system ). This aproach assumes that the individual is a rational agent who surveys the situation to see what the various options are and then does a quick cost-benefi t analysis of those options in order to choose. The second approach is to alter the context within which people act (known as the automatic system ). This type of intervention is similar to the “nudge” outlined by Thaler and Sustein (2008), which often involves small changes to the choice environment. For example, one intervention tried to encourage school children to make healthier choices without alienating students by reducing their perceived choices. In a school cafeteria, what kids choose depends on the order in which the items are displayed.

 Els que llegiu aquest blog ja sabeu que m'hi he referit anteriorment en termes genèrics. Però aquest llibre esdevé més interessant perquè mostra amb molta precisió un canvi de perspectiva. Destaco una conclusió del primer capítol:

Rational food decisions often involve trade-off between short-term gains of sensory pleasure and longer term gains of health and wellness. Findings from behavioral economics research suggest that even when people are motivated to make healthy choices, external constraints in the decision-making process can prevent them from choosing optimally. Most of us prefer immediately gratifying short-term pleasure over our long-term goal of eating healthy. Errors in choices arise from systemic decision biases, emotion, and the limits of cognitive capacity.

Atesa la importància de "l'epidèmia" potser caldria que més d'un hi fes una ullada. Encara que també vull anunciar que el capítol d'implicacions per a la política (el 12) és molt fluix. Us caldrà doncs una mica d'imaginació i reescriu-re'l vosaltres mateixos.

 No us perdeu les friky-fotos de Diane Arbus al Jeu de Paume

(suggerit per un lector del blog i que em plau compartir amb valtros)

PS. Les retallades són notícia a la CNN, (confonen Catalunya amb Espanya, treball periodístic de nivell...)

Public Health Priorities

Start Well, Live Better: A Manifesto for the Public’s Health. London: UK Faculty of Public Health, 2014

These are the 12 suggested priorities for public health in UK for the next 5 years:

Give every child a good start in life

• Give all babies the best possible start in life by implementing the recommendations of the 1001 Critical Days cross-party report
• Help children and young people develop essential life skills and make Personal, Social, Health and Economic, and Sex and Relationship Education a statutory duty in all schools

• Promote healthy, active lifestyles in children and young people by reinstating at least 2 h per week of physical activity in all schools

Introduce good laws to prevent bad health and save lives

• Protect our children by stopping the marketing of foods high in sugar, salt and fat before the 9 pm watershed on TV, and tighten the regulations for online marketing
• Introduce a 20% duty on sugar-sweetened beverages as an important measure to tackle obesity and dental
• caries—particularly in children
• Tackle alcohol-related harm by introducing a minimum unit price for alcohol of at least 50 p per unit of alcohol sold
• Save lives through the rapid implementation of standardised tobacco packaging
• Set 20 m.p.h. as the maximum speed limit in built-up areas to cut road deaths and injuries, and reduce inequalities

Help people live healthier lives

• Enable people to achieve a good quality of life, health and wellbeing—give everyone in paid employment and training a ‘living wage’
• Reaffirm commitment to universal healthcare system, free at the point of use, funded by general taxation

Take national action to tackle a global problem

• Invest in public transport and active transport to promote good health, and reduce our impact on climate change
• Implement a cross-national approach to meet climate change targets, including a rapid move to 100% renewables and a zero-carbon energy system

As you can see, many similar things with our PINSAP, the Health Policy Consensus and Health Plan. However, after yesterday news the pending issue of our public health is mainly alcohol abuse. We should focus on what works to reduce alcohol and addictive substance abuse. And first of all, we need to understand the foundations and best approaches to the problem. I would suggest you have a look at this book and specially this one:

PS. Binge drinking 'costing UK taxpayers £4.9bn'  Does anybody know how much does it cost here???

PS. In Spain, publicly funded health expenditure reached 64.150 million € in 2012,the amount for financial system bailout was 101.283 million € (p.24). Don't forget it: these are the priorities.

Exercise as a socially contagious activity

Exercise contagion in a global social network

Disciplines as diverse as economics, sociology, medicine, computer science, political science and physics have recently become interested in the interdependence of behaviours across the human social network. In particular, scientists have begun to ask whether our health and other behaviours are contagious, in that our decisions and actions affect the decisions and actions of our peers. If behavioural contagions exist, understanding how, when and to what extent they manifest in different behaviours will enable us to transition from independent intervention strategies to more effective interdependent interventions that incorporate individuals’ social contexts into their treatments

A new  study offers some of the first hard evidence that health-related habits can spread — and so perhaps could be deliberately seeded and encouraged — by social influence and peer pressure. Previous research has sought such a contagious effect in factors such as obesity and smoking, but the results have been inconclusive.

Studies in social differences in health have a a new hurdle to tackle. How to boost social permeability? As Mackenback said in The Lancet on health inequalities: now it's personal.

PS. These are the results of the study in one figure:

The Health of Catalans

La salut de la població de Catalunya en el context europeu

Comparing population health between countries allows to understand the scope of the differences. Some of them are unwarranted and others require an explanation. Anyway, it is good to confirm in a new report that the health of catalans has achieved a top level in Europe. The key indicator is healthy live years. As a summary it works, but when you go into details, then some  problems arise: obesity, tobacco, colon cancer, diabetes,...
Comparing public expenditures , Catalonia spends less than other countries with similar GDP. And the opposite is true for private expenditures (p.16). Unfortunately, data is  from 2010 and things have changed a lot, on GDP and health expenditure. My guess is that right now we are spending publicly a larger percentage than 6%. An update is needed in order to know better our current position.

Health behaviors and behavior change

 Behavioral Economics and Public Health

Health behaviors and practices constitute the foundation of good physical and mental health. The leading contributors to the global burden of disease include tobacco smoking, low-quality diets, alcohol abuse, physical inactivity, and obesity. Accordingly, encouraging people to adopt—and maintain—healthy behaviors is a major objective of public health. 

Today I recommend this book and this is what you'll find inside:

Chapter 1: An Introduction to Behavioral Economics and Public Health. Christina A. Roberto and Ichiro Kawachi

Chapter 2: Intertemporal Choices for Health. Justin S. White and William H. Dow

Chapter 3: Maintenance of Healthy Behaviors: Forming and Changing Habits. Dennis Rünger and Wendy Wood

Chapter 4: Emotions and Health Decision-Making: Extending the Appraisal Tendency Framework to Improve Health and Health Care. Rebecca Ferrer, William Klein, Jennifer Lerner, Valerie Reyna, and Dacher Keltner

Chapter 5: Social Norms, Beliefs, and Health. Brent McFerran

Chapter 6: Communicating for action: the importance of memorability and actionability. Jason Riis and Rebecca K. Ratner

Chapter 7:Nudging Individuals Toward Healthier Food Choices with the 4Ps Framework for Behavior Change. Zoë Chance, Ravi Dhar, Michelle Hatzis, and Kim Huskey

Chapter 8: Incentivizing Health Behaviors. Kristina Lewis and Jason Block

Chapter 9: Slim By Design: Moving from Can't to CAN.Brian Wansink

Chapter 10: Applying Behavioural Economics in a Health Policy Context: Dispatches from the front lines. Michael Sanders and Michael Hallsworth

Chapter 11: From Choice Architecture to Policy Infrastructure: Multi-Level Theory and the Political Economy of Health Behaviors. Frederick J. Zimmerman

On sugar and taxes

Should We Tax Sugar-Sweetened Beverages? An Overview of Theory and Evidence

The real question is how to tax the addiction industry. Sugar is only one case. Right now, these are the guiding principles (for sugar):

1. Focus on Counteracting Externalities and Internalities, Not on Minimizing
Sugary Drink Consumption
2. Target Policies to Reduce Consumption among People Generating the Largest
Externalities and Internalities
3. Tax Grams of Sugar, Not Ounces of Liquid
4. Tax Diet Drinks and Fruit Juice If and Only If They Also Cause Uninternalized
Health Harms
5. When Judging Regressivity, Consider Internality Benefits, Not Just Who Pays the
Taxes
6. If Possible, Implement Taxes Statewide
7. The Benefits of Sugar-Sweetened Beverage Taxes Probably Exceed Their Costs

Furthermore, sugar-sweetened beverage taxes are not a panacea—they will not, by themselves, solve the obesity epidemic in America or elsewhere. But sin taxes have proven to be a feasible and effective policy instrument in other domains, and the evidence suggests that the benefits of sugar-sweetened beverage taxes likely exceed the costs

 Robert Frank

Are You What You Eat?

Are You What You Eat? Healthy Behaviour and Risk Preferences

I am not strictly a fan of economic experiments. They are useful, but usually researchers achieve conclusions from samples and settings that are far from what happens really in population and geographies. However, some days ago I was looking at an article that it seemed of interest. They try to:

estimate the degree of risk aversion for a sample of young healthy adults and we explore its links with a broad range of risky behaviours considered together. Second, as indicator of the overall quality of diet, we complement, for the first time, the BMI with the Healthy Eating Index (HEI), and we relate both to estimated risk preferences

Sounds good, because the use of Body Mass Index is absolutely outdated and its relationship with risk aversion is crucial. This is the summary:

Our results show that risk preferences significantly differ across young adults with different, not extreme, health conditions. In particular, they reinstate the importance of conducting analyses that look separately at the two sub-samples of female and male subjects . This allows disentangling the links and interactions between preferences and key health variables such as smoking, and also to fully account for the gender-specific effects of the BMI and of alternative indicators of healthy weight.

Second, in our sample young women do not show any significant robust associations between risk preferences and BMI. Third, for young men – but not women – the HEI index appears to be significantly and consistently associated with risk preferences: across all specifications, healthier nutritional habits, tend to be robustly associated with higher risk aversion. This, together with the lack of significance of BMI-based indexes, suggests that, for subjects with not extreme health conditions, there is a wide scope to use measures alternative (or complementary) to the BMI, as indicators of the overall quality of diet.

That's it. And his final recommendation:

 From a health policy perspective, our study suggests that in young adults who have not yet developed chronic or extreme health conditions, looking at a comprehensive nutritional indicator such as the HEI could provide more direct insights to the deeply rooted behavioural mechanisms that drive health behaviours than considering an indirect and increasingly questioned measure such as the BMI.

Since children's obesity is one of the main challenges for health improvement, someone should take into account this message.

PS. Eliciting risk and time preference, the 2008 key article.

 Nancy Vieira

Precision medicine

 Precision Medicine for Investigators, Practitioners and Providers

Many topics under the same umbrella:

Table of Contents

Introduction

2. Role of genomics in precision medicine

3. High throughput omics in the precision medicine ecosystem

4. Infant gut microbiome

5. Paraprebiotics

6. Fecal transplantation in autoimmune disease

7. Drug pharmacomicrobiomics

8. CRISPR technology for genome editing

9. Engineering microbial living therapeutics

10. Organ on a chip

11. Multicellular in-vitro organ systems

12. The role of biobanks in biomarker development

13. Translational interest of immune profiling

14. Organoid pharmacotyping

15. Large datasets for genomic investigation

16. Modern applications of neurogenetics

17. Genomic profiling in cancer

18. Genomics in pediatrics

19. Genomics of gastric cancer

20.  Genomics of prostate cancer

21. MicroRNAs and inflammation markers in obesity

22. MiRNA sequencing for myocardial infarction screening

23. Cell free DNA in hepatocellular carcinoma

24. Non coding RNA in cancer

25. Germline variants and childhood cancer

26. Pharmacogenomics in cancer

27. Proteomic biomarkers in vireoretinal disease

28. Proteomics in respiratory diseases

29. Cardiovascular proteomics

30. Host genetics, microbiome, and inflammatory bowel disease

31. Sampling, Analyzing, and Integrating Microbiome ‘omics Data in a Translational Clinical Setting

32. Omics and microbiome in sepsis

33. Molecular and omics methods for invasive candidiasis

34. Lipid metabolism in colorectal cancer

35. Salivary volatolome in breast cancer

36. immunodiagnosis in leprosy

37. decision support systems in breast cancer

38. Electronic medical records and diabetes phenotyping

39. Clinical signature of suicide risk

40. Machine learning and cluster analysis in critical care

41. Artificial intelligence in gastroenterology

42. Algorithms for epileptic seizure prediction

43. Precision medicine in ophthalmology

44. Phenotyping COPD

45. Lifestyle medicine

46. Precision medicine for a healthier world

47. Aging and clustering of functional brain networks

48. Nutrigenetics

49. Genome editing in reproductive medicine

50. MRI guided prostate biopsy

51. Precision Nutrition

52. Theranostics in precision oncology

53. Precision medicine in daily practice

54. Imaging in precision medicine

55. Organoid for drug screening

56. Printing of personalized medication using binder jetting 3D printer

57. 3 D printing in orthopedic trauma

58. Consumer genetic testing tools in depression

59. The future of wearables

60. Tumor heterogeneity and drug development

61. Smartphone based clinical diagnosis

62. Smartphone biosensing for point of care use

63. Data security and patient protection

64. Blockchain solutions for healthcare

65. Ethical questions in gene therapy

66. Pitfalls of organ on a chip technologies

67. Regulatory issues of artificial intelligence in radiology

68. Academic industrial alliance

69. The future of precision medicine

70. Precision Medicine Glossary

71. Useful internet sites